Healthcare Provider Details

I. General information

NPI: 1427355015
Provider Name (Legal Business Name): ALEX ANTONIO MORALES-CABAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4126
US

IV. Provider business mailing address

2575 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4126
US

V. Phone/Fax

Practice location:
  • Phone: 321-454-7148
  • Fax: 321-449-5015
Mailing address:
  • Phone: 321-454-7148
  • Fax: 321-449-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN357
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5111
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: